Journal Article 1)
Cigarette smoking is the leading cause of premature mortality in western countries and it is important for smokers to stop as early as possible. Electronic cigarettes are a popular phenomenon of global proportion. Recent uncontrolled studies, reported that a certain number of smokers have quit using electronic cigarettes. This could hint a role for electronic cigarettes to be used for smoking cessation, and therefore merits further evaluation for this purpose.
Besides vaporising nicotine to be inhaled, electronic cigarettes may also provide a coping mechanism for conditioned smoking cues by replacing some of the rituals associated with smoking gestures, and for these reasons cigarette could become a tool – if studied more extensively – in the fight against tobacco- related morbidity and mortality.
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According to the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) a significant reduction in the health burden of tobacco in the medium term may be obtained by encouraging cessation among smokers . Therefore, a broader range of strategies are needed in order to fight against tobacco-related morbidity and mortality.
Unfortunately, efficacy of evidence based smoking cessation treatments is modest and far too many smokers are unwilling or unable to quit.
Electronic cigarettes, for its specific characteristics, could be used as a lower risk substitute for tobacco cigarettes. This tool may prove to be a hopeful solution for reduction in the use of traditional cigarettes and their related risk, with the pros of these products clearly outweighing the cons (table 2).
This electronic device delivers a nicotine vapour without the combustion products that are responsible for nearly all of smoking’s harmful effects. It use the process of vaporisation rather than combustion and the low operating temperature of the atomizer (less than 80°C) suggests that this tool are unlikely to emit cigarette toxicants . In contrast, temperatures of up to 950 degrees are generated with each puff of a lit cigarette and some 5000 or so chemicals, many of which are toxic or carcinogenic, are generated during the combustion process .
Although the reduction in health risks for people who use electronic cigarettes has not been quantified, we estimate it as similar to that reported for smokeless tobacco, which has approximately 1% of the death risk of smoking . E-cigarettes may contain nicotine, which contributes to cigarette addiction and helps sustain tobacco use.
However, if many smokers, not willing to quit, can convey their cigarette dependence to a less-harmful delivery method, millions of lives could be saved around the world.
Clearly, these tools need to be effectively regulated, but thus far, there have been diverse regulatory responses ranging from no regulation to complete bans. WHO’s Study Group on Tobacco Product Regulation advised a precautionary approach to electronic cigarettes  and, with a small number of exceptions, most national regulatory agencies have also adopted an analogous approach. The experimental basis for this regulatory approach is vague, and more appropriate research on electronic cigarettes must be conducted in order to ensure that the decisions of regulators, healthcare providers and consumers are based on evidence based medicine.
In the absence of specific evidence, it is important that currently marketed electronic cigarettes must comply with the best possible quality standards. For example, regulations should ensure that the liquid is manufactured under sanitary conditions and uses pharmaceutical grade or USP grade ingredients, and that a listing of all ingredients and information on the percent of nicotine present, if any, should be explicitly stated.
The dream of a cigarettes – free world is just that – a dream. Nicotine’s effects, observed in nicotine consumers, include correcting problems with the ability to remember, pay attention, and concentrate, as well as improving symptoms of mood disorders. Keeping such disabilities at bay right now can be much stronger motivation to continue smoke cigarettes than any threats of diseases that may strike years and years in the future. For smokers unwilling to quit, nicotine’s effects can be harnessed and the harmful effects of the delivery mechanism can be attenuated by providing nicotine from less dangerous sources than inhaling tobacco smoke. For these reasons electronic cigarette could become a promising tool – if studied more extensively and deeply – in the fight against tobacco-related morbidity and mortality.